A quality improvement audit of diabetes care in Macassar Community Health Centre
Thesis (MFamMed)--Stellenbosch University, 2011.
ENGLISH SUMMARY : Background: The responsibility for the management of diabetes mellitus, a highly prevalent and serious chronic condition, falls mostly on our primary health care services. Macassar Community Health Centre (CHC) in the Western Cape provides care for over 1000 patients with diabetes. Many studies show that disease and case management can improve patient care for chronic illnesses and the researcher decided to assess the management of diabetic patients at this CHC. Aim: To perform an audit on diabetes care in the Macassar Community Health Centre population and implement a cycle of quality improvement. Methods: An audit (as part of a quality improvement cycle) was done to assess the standard of care as reflected in 2009. Two hundred and fifty patient folders were selected randomly and assessed. A year of interventions, including training of staff and the use of a patient-held chronic care card took place. This was followed by a second audit of 250 folders from 2010, and the results were compared. Results: Most of the targets for structure outcomes were achieved, yet only 3 out of 13 process outcomes, and 3 out of 11 patient outcomes were achieved. In general there was an improvement in all outcomes with the second audit yet some issues will still need particular attention in the next quality improvement cycle. There was a big difference between these results and the Integrated Audit of Chronic Disease Management of 2009 which only looked at 10 folders, for example the CDM audit found that 75% of HbA1c’s were under 7, yet in this audit which assessed the same year, only 5% of HbA1c’s were under 7. Conclusion: The study was successful in determining the current standard of care of diabetics at Macassar CHC and commencing a cycle of quality improvement. An audit team was created and involved in setting target standards. They possibly overestimated their current standards when setting the targets which explain why only 3 out 13 process outcomes, and 3 out of 11 patient outcomes were achieved in the second audit, despite the general improvements after the cycle of interventions. Retinal photography is available and must be fully utilised by staff and patients. Foot examinations need to take place more frequently with prevention of complications being the focus. Hand-held patient cards were handed out to most of the patients, but this intervention would have to be assessed separately with a different research tool to assess its particular impact on improved management of diabetics. The audit also showed the need for both training of the clinic staff, as well as patients in the future. The quality improvement cycle should continue with new interventions taking place and periods of reflection, until the target standards are met.
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